BILL NUMBER: AB 1760	CHAPTERED  07/21/00

	CHAPTER   148
	FILED WITH SECRETARY OF STATE   JULY 21, 2000
	APPROVED BY GOVERNOR   JULY 21, 2000
	PASSED THE SENATE   JULY 6, 2000
	PASSED THE ASSEMBLY   APRIL 24, 2000

INTRODUCED BY   Assembly Member Kuehl

                        JANUARY 18, 2000

   An act to amend Section 1276.4 of the Health and Safety Code,
relating to health facilities, and declaring the urgency thereof, to
take effect immediately.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 1760, Kuehl.  Health facilities:  regulations.
   Existing law relating to the regulation of health facilities
requires the State Department of Health Services, by January 1, 2001,
to adopt specified regulations with respect to licensed
nurse-to-patient ratios for licensed health facilities, as defined.
Existing law authorizes a county hospital in Los Angeles County to be
subject to a phasein process with respect to these regulations.
   This bill would extend the date for adoption of these regulations
by the department to January 1, 2002, and would delete the phasein
provisions for the county hospital in the county of the first class.

   This bill would declare that it is to take effect immediately as
an urgency statute.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  Section 1276.4 of the Health and Safety Code is amended
to read:
   1276.4.  (a) By January 1, 2002, the State Department of Health
Services shall adopt regulations that establish minimum, specific,
and numerical licensed nurse-to-patient ratios by licensed nurse
classification and by hospital unit for all health facilities
licensed pursuant to subdivision (a), (b), or (f) of Section 1250.
The department shall adopt these regulations in accordance with the
department's licensing and certification regulations as stated in
Sections 70053.2, 70215, and 70217 of Title 22 of the California Code
of Regulations, and the professional and vocational regulations in
Section 1443.5 of Title 16 of the California Code of Regulations.
The department shall review these regulations five years after
adoption and shall report to the Legislature regarding any proposed
changes.  Flexibility shall be considered by the department for rural
general acute care hospitals in response to their special needs.  As
used in this subdivision, "hospital unit" means a critical care
unit, burn unit, labor and delivery room, postanesthesia service
area, emergency department, operating room, pediatric unit,
step-down/intermediate care unit, specialty care unit, telemetry
unit, general medical care unit, subacute care unit, and transitional
inpatient care unit.  The regulation addressing the emergency
department shall distinguish between regularly scheduled core staff
licensed nurses and additional licensed nurses required to care for
critical care patients in the emergency department.
   (b) These ratios shall constitute the minimum number of registered
and licensed nurses that shall be allocated.  Additional staff shall
be assigned in accordance with a documented patient classification
system for determining nursing care requirements, including the
severity of the illness, the need for specialized equipment and
technology, the complexity of clinical judgment needed to design,
implement, and evaluate the patient care plan and the ability for
self-care, and the licensure of the personnel required for care.
   (c) "Critical care unit" as used in this section means a unit that
is established to safeguard and protect patients whose severity of
medical conditions requires continuous monitoring, and complex
intervention by licensed nurses.
   (d) All health facilities licensed under subdivision (a), (b), or
(f) of Section 1250 shall adopt written policies and procedures for
training and orientation of nursing staff.
   (e) No registered nurse shall be assigned to a nursing unit or
clinical area unless that nurse has first received orientation in
that clinical area sufficient to provide competent care to patients
in that area, and has demonstrated current competence in providing
care in that area.
   (f) The written policies and procedures for orientation of nursing
staff shall require that all temporary personnel shall receive
orientation and be subject to competency validation consistent with
Sections 70016.1 and 70214 of Title 22 of the California Code of
Regulations.
   (g) Requests for waivers to this section that do not jeopardize
the health, safety, and well-being of patients affected and that are
needed for increased operational efficiency may be granted by the
state department to rural general acute care hospitals meeting the
criteria set forth in Section 70059.1 of Title 22 of the California
Code of Regulations.
   (h) In case of conflict between this section and any provision or
regulation defining the scope of nursing practice, the scope of
practice provisions shall control.
   (i) The regulations adopted by the department shall augment and
not replace existing nurse-to-patient ratios that exist in regulation
or law for the intensive care units, the neonatal intensive care
units, or the operating room.
   (j) The regulations adopted by the department shall not replace
existing licensed staff-to-patient ratios for hospitals operated by
the State Department of Mental Health.
   (k) The regulations adopted by the department for health
facilities licensed under subdivision (b) of Section 1250 that are
not operated by the State Department of Mental Health shall take into
account the special needs of the patients served in the psychiatric
units.
   (l) The department may take into consideration the unique nature
of the University of California teaching hospitals as educational
institutions when establishing licensed nurse-to-patient ratios.  The
department shall coordinate with the Board of Registered Nursing to
ensure that staffing ratios are consistent with the Board of
Registered Nursing approved nursing education requirements.  This
includes nursing clinical experience incidental to a work-study
program rendered in a University of California clinical facility
approved by the Board of Registered Nursing provided there will be
sufficient direct care registered nurse preceptors available to
ensure safe patient care.
  SEC. 2.  This act is an urgency statute necessary for the immediate
preservation of the public peace, health, or safety within the
meaning of Article IV of the Constitution and shall go into immediate
effect.  The facts constituting the necessity are:
   In order to allow the State Department of Health Services
sufficient time to develop regulations that establish licensed
nurse-to-patient ratios for licensed health facilities as prescribed
by existing law, it is necessary that this act take effect
immediately.
